Nursing care plan for an eighteen-year-old client with low self-esteem

Nursing Care Plan: Low Self-Esteem

Nursing Care Plan

low self-esteem

Client is 18 years of age and presents with vomiting, weight loss, diarrhea and persistent headache for last few weeks. Client reports she is presently taking a course on tourism in a private school and that her elder sister is pursuing a degree in medicine at an Ivy League college. Her younger brother attends a top-ranked high school and will graduate this year. The client's father is an attorney and her mother is a banker. The client's family lives in a posh mansion and employ a foreign domestic helper.

The client's history reveals that 'Jaslyn' has always been a quiet girl and doesn't have many friends. Jaslyn's parents are seldom at home and while they are very proud of the achievements of their eldest daughter and their youngest son Jaslyn failed to gain admission to college due to her poor achievement in high school. Jaslyn was therefore, enrolled in a private school by her parents. Since having left high school Jaslyn has pretty much become a loner and doesn't keep in contact with her friends from high school and in fact, Jaslyn sits on the corner of her bed and stares at the floor much of the time. Jaslyn feels ashamed that she is not smart like her siblings and knows her parents are highly disappointed in her. Jaslyn feels completely useless and doesn't know what to do. Jaslyn wishes for cancer so she can die.

III. PHYSICAL ASSESSMENT:

Height: 1.6m = 5.5 ft

Weight: 45kg = 99.21 lbs.

BP: 90/60

BMI

Respiration: 12 bpm

Pulse: 60 bpm

IV. GOAL

Develop a nursing care plan for this client through use of the nursing process while demonstrating critical thinking skills in formulating the best plan of care for this individual client.

VI. ASSESSMENT of CLIENT

There are various issues that must be considered carefully when assessing the patient and developing a nursing plan for this client toward implementing the most effective treatment plan possible. The role of the Nurse in this specific case study is one of assisting the patient in achieving the most positive possible outcomes in patient safety and health. First, depression may derive from biological as well as psychological roots. This client is underweight for her height. Furthermore, she is a loner and does not keep in touch with her old friends choosing instead to avoid social situations. Low self-esteem is evident in this particular case. Her siblings are both high-achievers while Jaslyn is not. Depression is clearly a factor affecting this young female. This patient should be tested for not only depression but as well should likely be tested for learning disabilities due to her difficulties in school. The work of Logsdon (nd) entitled: "Depression in Adolescent Girls: Screening and Treatment Strategies for Primary Care Providers" states: "Depressed adolescent girls were less masculine and had parents who were more traditional than did girls who were not depressed. Other studies have found that adolescent girls who are depressed tend to be stressed, lack social support, use physical health services more frequently, and have low socioeconomic status. Adolescent girls experience more stressful events than adolescent boys do and have stronger reactions to these events." Logsdon states that various theoretical frameworks have been created upon which to place the reasoning of why it is that adolescent girls are more likely to experience depression. Three explanations which are provided in Logsdon's work are those as follows: (1)Increased oxytocin present in girls at puberty leads to increases in affiliative behavior and a need for emotional connectiveness." (Logsdon, nd) Logsdon relates that it is common for girls to feel a 'sense of loss leading to depression'. (2) Adolescents girls become aware of society's expectations about proper behavior for women. Girls are sensitive to signals from others that their actions are or are not appropriate, and negative feedback may lead to feelings of depression. Most researchers agree on the importance of relationships to adolescent girls and the role of "disconnected relationships." (Logsdon, nd) and (3) adolescents girls accept the stereo typical ideal of an extremely thin physical appearance which leads to dissatisfaction with their body shape and increased depression." (Logsdon, nd) Evans writes regarding anorexia that "Parental care appears to be a key developmental risk factor to anorexia, whether insufficient care reflects a personal style in the parents or is a consequence of parental separation, marital discord, socioeconomic privation or other factors. A lack of appropriate parental care (responsiveness and acceptance) apparently fixates the individual to a sense of helplessness, engenders feelings of inferiority and self-disparagement, and makes the recipient more vulnerable to frustration or deprivation by subsequent relationships. Bowlby (1977) suggested that such parental deprivation engenders "anxious attachment," with the child being insecure, overly dependent under stress, depressed and disposed to develop neurotic symptoms. Specifically, deficient care may result in a child's being vulnerable as a consequence of a low intrinsic level of self-esteem and self-worth (Parker, Barrett, and Hickie, 1992). It is clear that a number of factors are likely to affect the teenaged individual resulting in depression and it is critically noted that this depression must necessarily be addressed, treated and resolved. The client in this instance has borderline low blood pressure which should be monitored several times each week and furthermore the body mass index (BMI) of this individual is excessively low indicating that this patient needs to be counseled in regards to their diet both in terms of quality and quantity of foods consumed.